| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,016 |
546 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,193 |
584 |
$61K |
| D1110 |
Prophylaxis - adult |
1,091 |
1,083 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
725 |
707 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
239 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
926 |
908 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
854 |
849 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
815 |
769 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
180 |
$11K |
| D0274 |
Bitewings - four radiographic images |
498 |
492 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,243 |
1,197 |
$8K |
| D4355 |
|
213 |
210 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
38 |
$6K |
| D1120 |
Prophylaxis - child |
144 |
144 |
$5K |
| D1206 |
Topical application of fluoride varnish |
229 |
229 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
775 |
607 |
$3K |
| D2332 |
|
48 |
29 |
$3K |
| D2331 |
|
45 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$720.00 |
| D0431 |
|
14 |
14 |
$0.00 |